A Relational Cultural Approach to Working With Clients With Eating Disorders

An examination of individual, relational, and cultural risk for disordered eating in Asian American college students

Objective: This study examined how individual (satisfaction of basic psychological needs), relational (perceived achievement- and dependency-oriented parental psychological control), and cultural (ethnic identity) factors may contribute to Asian American college students' (18 - 25 years of age) disordered eating. Participants: Asian American college students (N = 118) participated in the study. Methods: Participants completed a cross-sectional survey study. Moderated mediation models were used to analyze the data. Results: Analyses showed that perceived achievement-oriented, but not dependency-oriented, parental psychological control was more strongly associated with psychological needs satisfaction at higher, compared to lower, levels of ethnic identity. Conclusions: Findings highlighted the importance of both parenting and ethnic identity among Asian American college students' psychological needs and risk for disordered eating. The complex relations among achievement expectations, ethnic identity and wellbeing in Asian Americans are discussed. The results can inform intervention and prevention programs attending to the needs of this population.

Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman's Experiences of Bulimia Nervosa

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of 'bulimia.' It thereby offers an alternative portrait of relationships between eating disorders and 'culture,' one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment.